July 14, 2014

killer disease a Heavy Burden for Cash-Strapped Cuban Families

Sunday, December 8, 2013

Rationing for cancer

Patients at a chemotherapy session in the Civil Hospital in the province of Cienfuegos, Cuba.
By Ivet González

Although cancer treatment is free of cost, only extended networks of support help alleviate the economic impact of the disease, now the number-one cause of death.

HAVANA — The meagre budgets of Cuban families are put to the test when one of the members is diagnosed with cancer. Although treatment is free of cost, only extended networks of support help alleviate the economic impact of the disease, which is now the number one cause of death.

“The most expensive thing is the diet. We have to buy fruit, vegetables, chicken and fish, which are costly and hard to get,” said Adolfo (not his real name), who changed jobs four times in his efforts to help his wife through her 11-year battle with cancer, which she finally lost in September.

“One day I spent my entire two-week salary on fruit and vegetables. When I reached into my pocket for money to buy meat, it was empty,” the 61-year-old Adolfo said.

In Cuba, healthcare is free, and surgery, visits to specialists and treatments such as chemotherapy are universally available. However, following a healthy diet while under treatment, paying for transport to healthcare centres and other aspects become a heavy burden for families.

That problem is one of the hidden sides of this disease, which in 2012 caused one out of every four deaths in this country of 11.2 million, surpassing heart disease as the number one cause of death. The Public Health Ministry reports that some 30,000 new cases are now diagnosed annually, 2,000 more than in 2004, and it anticipates that the figure will rise to 35,000 in 2015.

Adolfo left his job as a manager at a state company to become a driver at a foreign company with better pay and a more flexible schedule.He says he was lucky to have that opportunity, an exceptional one for Cubans, who earn the equivalent of US$19 on average. Food is expensive, consuming 70 to 90 percent of family income, according to local economists.


“The ration book monthly quota (of food guaranteed at subsidised prices] and the special diet (by prescription) that every patient receives is just a support,” Adolfo explained. “And hiring a carer is almost impossible,” he added. His family is small, which is common in Cuban society, where the fertility rate is low: 1.69 children per woman.

A study published in April by the British journal The Lancet Oncology, “Planning Cancer Control in Latin America and the Caribbean,” estimated that in 2009 the financial burden of this disease in the region was US$4 billion and rising.

In addition to the direct costs of medical care, the report added indirect costs, such as loss of work days and productivity, among others.

Cancer and other non-transmissible diseases are surpassing infectious diseases in the region as the greatest threat to health, the study reported. However, the general incidence of cancer in Latin America is 163 cases per 100,000 inhabitants — much lower than in the European Union, where it is 264 per 100,000, or the USs, with 400 per 100,000.

Nevertheless, Latin America’s mortality/incidence ratio is 0.59 for all types of cancer, much higher than in the European Union, where it is 0.43, or the United States, with 0.35. In addition, it is estimated that between 2008 and 2020, the number of malignant tumour cases will rise by 42 percent throughout the region.

According to The Lancet, Cuba has the seventh highest incidence of cancer in the region, and a mortality/incidence ratio that is higher than the Latin American average, with 0.63, despite the fact that it is one of the Latin American nations that invests the greatest proportion of its GDP in public health: 9.7 percent.

In this country, which has been in an economic crisis for more than 20 years, solidarity during difficult times is a collective weapon of


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